A new sesquiterpene ester from Celastrus orbiculatus reversing multidrug resistance in cancer cells

PURPOSE: To compare the healing of the cornea and the incidence of infection after traumatic corneal epithelial defect after single treatment with double bandage combined with either Fucithalmic single unit dose eye drops or chloramphenicol eye ointment. METHODS: This is a single-centre, randomised, single-blind, parallel-group study of 144 patients with accidental corneal abrasion or corpus alieni cornea who were referred to the Eye Department at Gentofte Hospital. The injured eye was examined with a photo slit-lamp before and 24 hours after treatment. The size of the abrasion was recorded and calculated on a PCX computerized video system and by slit-lamp photography. RESULTS & CONCLUSION: The Fucithalmic and chloramphenicol ointment treated groups showed no significant difference in corneal healing, local side effects, or signs of local infection.     

Wound infection. A failure of wound healing caused by an imbalance of bacteria

Infection in a wound, like infection elsewhere in the body, is a manifestation of a disturbed host-bacteria equilibrium in favor of the bacteria. This not only elicits a systemic septic response but actually inhibits the multiple processes involved in the wound healing scheme. Each process involved in healing is affected when bacteria proliferate in a wound. Wound infection, whether in an intentional operative incision, an acute traumatic laceration, or a chronic pressure ulcer, results when bacteria indigenous to the patient or exogenous to the wound achieve dominance over the systemic and local factors of host resistance. To be able to prevent and manage wound infections requires an understanding of how each prophylactic or therapeutic maneuver works to maintain or re-establish the bacteria-host balance. Only when this equilibrium is in balance can the normal processes of wound healing proceed to give a satisfactory healing trajectory.     

Technic of overlapping sphincter anal repair in the treatment of traumatic anal incontinence

Faecal incontinence is an important disabling symptom in the affected patients. Classically, we divide faecal incontinence in two main types: neurogenic faecal incontinence and traumatic anal incontinence. Traumatic anal incontinence is due to causes damaging sphincteric mechanism directly. The aim of the present study was to evaluate the outcome of overlapping sphincter anal repair procedure in the management of traumatic anal incontinence. To this end we studied 27 patients with traumatic anal incontinence who underwent an overlapping sphincter anal repair procedure according to the method described by Parks and McPartlin in 1971. Mean follow up was up three years and was based mainly both on clinical evaluation with anorectal exploration and manometric values carried out on a 6 monthly basis. When the outcome was evaluated in terms of faecal continence our date were similar to those reported by Parks and Fang. In the subjects studied we haven't reported any major complications apart from one case of abscess, one case of wound's infection and one case of stenosis which were efficaciously treated. Our findings supported the view that overlapping sphincter anal repair procedure is the surgical approach of choice in the patients with traumatic anal incontinence.     

Adler's psychology (of use) today: Personal history of traumatic life events as a self-handicapping strategy.

Investigated the hypothesis that the reporting of a history of traumatic life events may serve as a strategy to control attributions about performance in an evaluative setting (i.e., self-handicapping). 140 female undergraduates completed the state form of the State-Trait Anxiety Inventory and were randomly assigned to 1 of 4 experimental conditions (i.e., 2 evaluation threats by 2 traumatic history instructions). In groups of 7, Ss received specific (the project concerned development of local norms for measures of social intelligence) or innocuous information. After completion of an initial questionnaire, Ss either were told that traumatic history has no effect on task performance or received no instructions about filling out measures of the traumatic value of past life experiences and 2 manipulation checks. Results, as predicted, show that Ss emphasized the adversity of events and experiences in their background when an uncertain evaluation was expected and when a traumatic background would serve as a suitable excuse for potential failure. Results generally support the hypothesized self-protective reporting of traumatic life events. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sternal osteomyelitis

The authors present data based on the analysis of diagnosis and treatment of 11 patients with sternal osteomyelitis which in 9 patients was of traumatic origin and in 2 was hematogenous. Early diagnosis is difficult. Clinical manifestations and roentgenography of the sternum are essential for diagnosis. In combined treatment of osteomyelitis preference is given to radical removal of osteomyelitic masses within healthy tissues with tamponade of the residual osteal cavity by local tissues.     

VEGF mRNA induction correlates with changes in the vascular architecture upon spinal cord damage in the rat

The multiple cellular and molecular processes induced by injury to the central nervous system (CNS) are still poorly understood. In the present study, we investigated the response of the vasculature and the expression of mRNA for the angiogenic vascular endothelial growth factor (VEGF) following X-irradiation of the spinal cord in the newborn and following traumatic spinal cord injury in the adult rat. Both lesion models induced changes in the density and the distribution pattern of blood vessels: while X-irradiation led to a permanent local increase in vascular density in the fibre tracts of the exposed segments, a transient local sprouting of vessels was induced upon traumatic spinal cord injury. In situ hybridization showed that an increase of VEGF mRNA anticipated and overlapped with the vascular responses in both lesion models. In addition to the temporal correlation of VEGF expression and vascular sprouting, there was a clear correlation in the spatial distribution patterns. Following X-irradiation, the expression of VEGF mRNA was restricted to the fibre tracts, precisely the areas where the changes in the vasculature were observed later on. Upon transection in the adult animal, VEGF was mainly detectable at the border of the lesion area, where the transient increase in vascular density could be observed. Interestingly, according to the type of lesion applied, astrocytes (X-irradiation) or inflammatory cells (presumably microglial cells or macrophages; traumatic lesion) are the cellular sources of VEGF mRNA. Our results strongly indicate that VEGF is crucially involved in mediating vascular changes following different types of injury in the CNS.     

Primary cutaneous cryptococcosis following trauma of the right forearm

A 62-year-old woman with sarcoidosis II, status post systemic steroid treatment, developed an inflammatory, infiltrative skin lesion in the area of a traumatic haematoma of the right forearm. The clinical appearance at first corresponded to bullous erysipelas. Antibiotic therapy, which was instituted immediately, proved to be ineffective. A microbiological swab revealed infection with Cryptococcus neoformans. A systemic cryptococcosis could be excluded. Therapy with 200 mg itraconazole twice daily resulted in a prompt improvement.     

Relations between intestinal motility and absorption

Chronic constrictive pericarditis following traumatic hemopericardium has been reported in recent years, but it has not been reproduced experimentally in dogs. The present study attempted to produce posttraumatic constrictive pericarditis in 34 experimental animals. Hemopericardium by means of trauma to the epicardium or pericardium was produced by a sharp instrument or by the injection of autologous blood inside the pericardial sac. All animals were killed at intervals between 3 and 31 months. The animals in which hemopericardium was induced by injecting blood into the pericardial cavity showed no changes. The hemopericardium was completely resolved without noticeable residual trace. Animals having hemopericardium as a result of trauma evidenced a well-developed constrictive pericarditis that was documented clinically, hemodynamically, and histologically. These experimental findings indicate that chronic constrictive pericarditis may well be due to traumatic hemopericardium rather than to specific infection.     

Functional interaction of the gp80 and gp130 IL-6 receptors in human B cell malignancies

This study investigated the psychological impact of HIV infection through assessment of posttraumatic stress disorder in response to HIV infection. Sixty-one HIV-positive homosexual/bisexual men were assessed for posttraumatic stress disorder in response to HIV infection (PTSD-HIV) using a modified PTSD module of the DIS-III-R. Thirty percent met criteria for a syndrome of posttraumatic stress disorder in response to HIV diagnosis (PTSD-HIV). In over one-third of the PTSD cases, the disorder had an onset greater than 6 months after initial HIV infection diagnosis. PTSD-HIV was associated with other psychiatric diagnoses, particularly the development of first episodes of major depression after HIV infection diagnosis. PTSD-HIV was significantly associated with a pre-HIV history of PTSD from other causes, and other pre-HIV psychiatric disorders and neuroticism scores, indicating a similarity with findings in studies of PTSD from other causes. The findings from this preliminary study suggest that a PTSD response to HIV diagnosis has clinical validity and requires further investigation in this population and other medically ill groups. The results support the inclusion of the diagnosis of life-threatening illness as a traumatic incident that may lead to a posttraumatic stress disorder, which is consistent with the DSM-IV criteria.     

Death caused by Perthes pressure congestion

In this paper considerations from the view-point of forensic examiners are presented on various issues in fatal traumatic asphyxia such as reconstruction and frequently difficult evaluation of the survival time. The study includes several autopsy cases with diverse mechanisms of compression and graduated importance of asphyxia for death. The reconstruction of the diagnosis of traumatic asphyxia was possible in a case of exhumation after more than 5 months in the synopsis of necropsy and judicial inquiry. Very short survival periods of minutes and compression times of seconds are sufficient for the production of the typical external characteristics. Thoracic compression can cause death within minutes (limiting factor: resuscitation time of the brain). In addition to other well-known local and general vitality markers, clods or parts of plants in the hands of the decedents can point to vain attempts of self-escape and confirm the diagnosis of vitality.     

Pubic tuberculous osteo-arthritis. Apropos of 2 cases

OBJECTIVE: The authors report an exceptional site of tuberculous osteo-articular infection which must be diagnosed before the destructive stage. OBSERVATIONS: Case 1 : a 21 years old woman presented an inflammatory pubic pain after a trauma with weight loss of 4 kgs in 3 weeks. She presented also 2 satellite inguinal nodes. Erythrocyte sedimentation rate (ESR) was elevated, X-rays showed an important osteolysis of the left ischio-pubic rami, tuberculous skin test (TST) was positive, mycobacterium tuberculosis (MT) could not be found neither in sputtum nor in urine but the node biopsy showed the specific features of tuberculosis. Evolution under a 6 months antibiotic treatment was good. Case 2 : a 19 years old woman, with history of tuberculous contagion, presented in April 1996 cervical nodes and a month later inflammatory pubic and knee pain with weight loss and vesperal sudation. ESR was elevated, TST was phlyctenular, MT searching and HIV serology were negative. X rays showed irregular osteolysis of the pubic symphysis. Scintigraphy showed an increased fixation of pubis and left knee. Cervical nodes biopsy diagnosed tuberculosis. Evolution was good under a 6 months antibiotic treatment. DISCUSSION: Many factors can favorize the development of a pubic tuberculosis and are similar for all forms of tuberculous osteo-articular infection (trauma and contagion in our cases). Radiological features, characterized by a slow evolution, are note specific. Diagnostic confirmation must be bacteriologic or pathologic, and if possible far from the pubic foci. Any traumatic medical procedure has to be avoided because of painful outcome and local risk. Evolution under specific treatment, even of short course (6 months), is sufficient for a good outcome. CONCLUSION: One must think to pubic tuberculous osteo-arthritis in any pubic pain even if it is post-traumatic especially, in endemic countries of tuberculosis.     

Symptomatic Helicobacter pylori infection in a neurorehabilitation population

Helicobacter pylori infection has been associated with acute and chronic gastritis, peptic ulcer disease, hypertension, and possibly gastric carcinoma and coronary artery disease. The prevalence of H pylori infection is more than 50% in people older than 60 years; however, the prevalence is not known in patients with traumatic brain injury (TBI) or cerebrovascular accidents who are treated in inpatient rehabilitation services. This report describes 10 symptomatic patients with TBI and strokes who were diagnosed with and treated for H pylori infection after transfer to a neurorehabilitation unit during a 12-month period. Physicians who treat patients with TBI and stroke need to be aware of the possible high prevalence of H pylori infection in their patients. The authors recommend H pylori screening for symptomatic patients in neurorehabilitation units and providing definitive treatment to prevent recurrent gastrointestinal bleeding, peptic ulcer disease, and gastritis.     

Traumatic neuroma of the nose

We report a case of a traumatic neuroma of the nose. It was an unusual site for two distinct types of tissue response to skin and soft trauma that exceeded the reparative needs of the body. In the first instance, a small cutaneous nerve was sectioned, and its inability to establish continuity distally resulted in a neuroma. In the second instance, the excision site of the neuroma was reinjured, and an abnormal connective tissue response occurred, resulting in a hypertrophic scar or keloid. Both were treated similarly with excision, and ultimately with local steroid injection with satisfactory results.     

Petit mal status in a patient with chronic renal failure

A 39-year-old woman with traumatic spinal paraplegia and chronic renal failure had peritoneal dialysis for acute renal failure precipitated by a bout of urinary tract infection. Two weeks after the dialysis she lapsed into coma for a few days. An electroencephalogram indicated petit mal stupor as it showed generalized epileptic discharges during the initial period of her coma.     

Neural basis for the genesis and control of digitalis arrhythmias

The author discussed the increase in the frequency of traumatic paralyses of the ocular muscles, and reported 6 cases of inferior oblique muscle paresis caused by local blunt or sharp traumas (haematoma, contusion, rupture, incarceration) and one case of traumatic Brownian pseudo-paralysis. The localisation of the injuries in 3 cases was on the inferior temporal part and in the other 3 cases on the superior part of the bulbar conjunctiva. Atypical horizontal deviation and characteristic vertical deviation, torsion and torticollis were observed in the majority of cases. One patient recovered spontaneously. 3 patients became asymptomatic after correction by prisms and one after recession of contralateral superior rectus muscle. The symptoms remained unchanged in the case of a "blow out" fracture (in spite of operation) and a Brown's syndrome (without treatment).     

An atypical infectious complication of anterior cervical surgery

An elderly patient suffering from the posttraumatic development of a superficial temporal artery (STA) aneurysm is described. Because the patient had renal dysfunction, angiography was performed through a direct puncture of the anterior branch of the STA in order to reduce the required dosage of contrast medium. With the patient under local anesthesia, the STA was ligated proximal and distal to the aneurysm, and thereafter removed. The diagnosis and treatment of traumatic STA aneurysms in the elderly are discussed.     

Sympathetic reflex control of subcutaneous blood flow in tetraplegic man during postural changes

1. The effect of head-up tilt upon subcutaneous blood flow in the distal arm and leg was studied in 12 patients with complete traumatic spinal cord transection at the cervical level. 2. Blood flow was measured by the local 133Xe washout technique. 3. Leg lowering induced a 47% decrease in blood flow in the distal leg. During head-up tilt (45 degrees) blood flow in the leg decreased by 48%. In the arm remaining at heart level blood flow decreased by 37% during tilt and this vasoconstriction could be prevented by nervous blockade with lignocaine injected subcutaneously 5 cm proximally to the labelled area. Leg blood flow was unaltered by proximal blockade but could be blocked by local infiltration in the labelled area with lignocaine in low doses. 4. Head-up tilt of tetraplegic patients induced vasoconstriction in the subcutaneous tissue of the forearm, which could be prevented by proximal blockade. Thus the vasoconstriction could be due to a spinal sympathetic reflex mechanism. This as well as local mechanisms including the venoarteriolar reflex may play a role in recovery of arterial blood pressure during head-up tilt in the tetraplegic patient.     

Teaching multiskilling in dietetics education

The reaction of oligodendrocytes in response to traumatic injury of the CNS are poorly understood. In the present report we studied changes in the expression of a major constituent of CNS myelin, myelin basic protein (MBP), by immunohistochemistry and in situ hybridization from 6 h up to 2 weeks following partial transection of the spinal cord in adult rats. MBP immunohistochemistry showed degeneration of myelin at the lesion center and signs of myelin breakdown in necrotic foci in the dorsal and ventral funiculi proximal and distal to the lesion. In situ hybridization revealed that mRNA for MBP was downregulated at the local lesion site within the first day following injury, probably reflecting oligodendrocytes to undergo cell death. From 2 days on, however, MBP mRNA was conspicuously upregulated at the border of the lesion area. This "reactive" response of surviving oligodendrocytes, as indicated by increased levels of MBP mRNA, peaked around 8 days. At this time, oligodendrocytes displaying strong MBP in situ signal formed stripe-like structures which were oriented radially toward the lesion center and arranged in parallel to neurofilament-positive axons. At around 2 weeks post-injury, MBP mRNA at the border of the lesion area was again downregulated to levels comparable to uninjured controls. These results show that traumatic injury of the spinal cord induces a "reactive" response of surviving oligodendrocytes adjacent to lesion sites. This response might represent an important component of local repair mechanisms.     

Intraorbital squamous epithelial cyst: an unusual complication of Silastic implantation

Thin Silastic sheet alloplasts (Dow Corning, Midland, MI, U.S.A) are commonly used to reconstruct posttraumatic orbital floor defects. Complications associated with orbital Silastic implantation include infection, migration, and extrusion. The authors report an unusual case of an intraorbital, squamous, epithelial-lined cyst appearing as progressive vertical globe dystopia and proptosis occurring after Silastic reconstruction of a traumatic orbital floor defect.